In the waiting room, an employee curtly tells the people present to not take any photographs and to switch off their cell phones. To confirm compliance, he even walks around peering over people’s shoulders.

At least two security cameras are attached to the ceiling.

One of the doors leading from the room bears the sign “Society of transplant physician [sic] and surgeons (head office)”.

These are not regular OPD hours and there are only about a dozen people in the waiting room. Leaning back against a two-seater is a young woman accompanied by a little boy about six years old, solemnly eating a packet of crisps. Her hands are rough and calloused, and her complexion has the sunburnt look of someone who works outdoors all day. A plastic bag with documents lies next to her.

The hospital staff asks that cell phones be left outside with them before the patients and their attendants go in to see the doctor.

In his office, the transplant surgeon, sporting a thick, jet-black moustache and wearing a flashy, diamond-edged gold watch, is in the midst of a consultation. The patient, who has developed liver problems, is referred to another doctor, a retired colonel, who the surgeon says, “sees all our patients”.

Turning to this reporter, unaware he is actually speaking to an undercover journalist, the surgeon agrees that charges for transplants are high:

A seven-day package, he says, which includes medication, transplantation and hospital stay costs Rs1.8m, including Rs600,000 if a donor is arranged from outside.

“Unrelated donors becomes a complicated issue, there are lots of legal aspects which we have to cover. Because of all this, the cost has gone up.”

RISE OF THE ORGAN TRAFFICKING RACKET

Organ trafficking is a practice that involves organs – almost always kidneys – purchased from living donors. It was criminalised in Pakistan when the Transplantation of Human Organs and Tissues Ordinance was promulgated in 2007. That briefly led to a steep drop in transplants using vended kidneys, estimated at around 2,000 per year earlier.

Despite aggressive efforts mounted by the influential pro-organ trade lobby to derail the Ordinance before it could become law, the anti-organ trade campaigners won the day and in 2010, the National Assembly and Senate passed the Transplantation of Human Organs and Tissues Act.

The law lays emphasis on organ donation that is “voluntary, genuinely motivated, not under duress or coerced”. It says that if a donor is not available within a patient’s immediate family (parents, siblings, spouse and offspring), “a non-close living blood relative” willing to donate his organ can do so provided an evaluation committee of the transplantation facility concerned is satisfied that no financial consideration is involved. Only in very special circumstances — such as unavailability of a family donor — can a non-related person donate an organ, provided there is no financial compensation.

Under the 2007 ordinance, a national body — the Human Organ Transplantation Authority (HOTA) — was formed to register, regulate and monitor institutions offering transplants in the country. After devolution, provincial HOTAs were set up to discharge this regulatory function and the erstwhile federal HOTA assumed responsibility for Islamabad Capital Territory alone.

The 2010 law appeared to have brought down the number of illegal transplants — that is, until two or three years ago. Since then, say several leading urologists in the country, organ trafficking has once again become a flourishing racket.

WEB OF HOSPITALS

The institution in Rawalpindi profiled above is far from the only offender. Multiple sources as well as kidney donors to whom Dawn spoke pointed to another hospital in the same city, as well as several in Lahore and Islamabad, and certain urologists and nephrologists affiliated with these institutions who carry out transplants using vended kidneys.

There are also a number of other medical facilities, some of them fly-by-night clinics in rented premises, involved in this illegal, unethical practice that preys upon the poorest of the poor.

Given the areas where such criminal activity is centred, Punjab HOTA and federal HOTA, as well as the evaluation committees giving the go-ahead for these illegal transplants, have much to answer for.

“In a country like Pakistan, where families tend to be large, suitable related donors should be easily available,” Dr Philip O’Connell, president of the Transplantation Society of Australia, told Dawn while on a working visit to Karachi.

According to a study cited at a Harvard conference in 2008.

“If you have siblings, there’s a 25pc chance you’ll have a perfect match among them, a 50pc chance there will be a 50pc match, and a 25pc chance there will be a zero match. But even with a zero match, transplants can be carried out in most cases, provided a few conditions are met, such as the same blood group. To say an organ will have to be purchased because there’s ‘no match’, it’s just a game.”

Another Australia-based kidney specialist accompanying him, Dr Jeremy Chapman, who is recognised as one of the foremost experts in the field of transplantation, added: “On the one hand, you have desperate, uninformed, wealthy patients who think they’ll die without a transplant; on the other, there are profit-driven doctors who will take those patients to the cleaners.”

The story was first published in Dawn newspaper and is republished here with due permission of the author.

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